Medical Ophthalmology (Ophthalmic Medicine) is an emerging medical specialty in the United Kingdom. In the future it is expected that there will be one ophthalmic physician (medical ophthalmologist) per population of 263,000. The primary purpose of the specialty is the medical assessment, investigation, diagnosis and management of disorders affecting vision, particularly:
- Inflammatory disorders affecting vision (e.g. uveitis, scleritis, corneal graft rejection, systemic vasculitis
- Vascular disorders affecting vision (e.g. diabetes, arteriosclerosis, hypertension, stroke)
- Neurological disorders affecting vision (e.g. multiple sclerosis, stroke, pituitary disorders, thyroid eye disease)
- Public visual health (e.g. diabetic retinopathy screening)
Other important aspects include:
- Genetic disorders affecting vision (e.g. retinitis pigmentosa)
- Retina specific disorders affecting vision (e.g. age-related macular degeneration)
- Visual rehabilitation (e.g. age-related macular degeneration)
- Ophthalmic procedures particularly laser therapy for diabetic retinopathy and local injection therapy for age-related macular degeneration
50% of the new referrals to ophthalmology that require intervention or specialist follow up are medical in nature and benefit from the expertise of a clinician with expertise in internal medicine. The 2000 Royal College of Ophthalmologists Survey of Demand for Medical Ophthalmology in the United Kingdom found that many units wished to have an ophthalmic physician to enable them to deliver effective care. Inflammatory eye disease is a particular issue. A 2005 survey, conducted by ophthalmologists with an interest in uveitis in Scotland, revealed a marked variation in the delivery of immunosuppression for sight-threatening uveitis, the commonest cause of treatable blindness in young adults. Expertise in ophthalmic medicine is also appropriate for diabetes where the prevalence is expected to rise by 60% in the next decade as a consequence of the ageing population and the epidemic of obesity. As the eye is a direct extension of the brain, then expertise in neurology is beneficial as many patients with visual disorders have conditions affecting the brain and its pathways rather than the eye itself.
The ophthalmic physician requires to have varied clinical skills beyond expertise in the assessment and diagnosis of visual symptoms and signs. He or she must have expertise in immunosuppression, neurology and cardiovascular medicine. In addition many ophthalmic physicians will be involved in managing large diabetic retinopathy screening programmes, which require organisational and public health skills. Some will be required to manage retina-specific disorders requiring practical skills such as laser therapy and intra-ocular injections.
Ophthalmic medicine is a fascinating and rewarding specialty. It is predominantly out-patient based. The workload of an ophthalmic physician is varied ranging from the personal delivery of care such as laser therapy for diabetic retinopathy through to the intellectual challenge of neuro-ophthalmic disorders. It is also very rewarding with the majority of conditions responsive to therapy.
Competence Based Curricula and Assessment - StRs (for trainees who commenced training from 1 August 2007 to present)
There are two versions of curricula for this training period:
StRs who commenced training between 1st August 2007 and 3rd August 2010 will follow the 2007 version of their specialty curriculum and the 2007 Generic curriculum. Please see the 2007 Curriculum section of this webpage.
StRs who commenced training from 4th August 2010 onwards will use the 2010 version of their specialty curriculum. There is no need to follow the previously known ‘Generic curriculum' as this has now been embedded into the specialty curriculum. Please see the 2010 Curriculum section of this webpage.
The Joint Royal Colleges of Physicians Training Board (JRCPTB) is pleased to announce the 2010 Medical Ophthalmology curriculum which has been reviewed and rewritten to:
meet the GMC's 6 new standards as detailed in their Standards for Curricula and Assessment systems
keep up to date with medical advances and changes in the service and training
incorporate the framework documents produced by the Academy of Medical Royal Colleges (AoMRC) detailing Common, Medical Leadership and Health Inequality competencies
include 5 new assessment methods (Acute Care Assessment Tool, Case based Discussion, Patient Survey, Teaching Observation and Audit Assessment).
This new curriculum has improved content, design and usability compared to its predecessors, and reflects a great deal of hard work and time expended by specialty curriculum groups. This curriculum will become the training manual for all trainees entering ST3 from 4th August 2010.
For further information on the 2010 curriculum it is recommended that you read the Quick Start Curriculum Guide.
If you have any queries or problems regarding the 2010 curriculum please email ptb@jrcptb.org.uk.
Core Training Programmes
Entry into Medical Ophthalmology training is possible following successful completion of both a foundation programme and a core training programme.
There are 2 core training programmes for Medical Ophthalmology training:
Assessment
The following methods are used as part of the integrated assessment system:
- Knowledge Based Assessments - The small size of the specialty means that it is not feasible to run a full specialty certificate examination to assess knowledge. The specialty is currently planning to pilot a formative knowledge-based assessment method and, if successful, it is intended that this method will be used in the future - details to follow.
- Workplace-based assessments
The assessment blueprint, which is embedded in the clinical syllabus, shows the possible methods that can be used to assess each of the competencies in the curriculum. Trainees and trainers should refer to the blueprint for guidance on the appropriate assessment methods for each aspect of the curriculum, and so plan the training programme according to the criteria set by the ARCP Decision Aid. It is not expected that all competencies will be assessed by all methods, rather that there will be a sampling of competencies within a variety of settings, both within formal and workplace-based assessment, from which overall competence acquisition has to be determined.
The diagrams below describes the possible training pathways:
Please view the 2010 curriculum for Medical Ophthalmology for full details on the training routes and selection criteria.
Entry into Medical Ophthalmology training is possible following successful completion of both a foundation programme and a core training programme.
Please view the 2007 curriculum for Medical Ophthalmology for full details on the training routes and selection criteria.
Assessment
The assessment blueprints show the possible methods that can be used to assess each of the competencies in the curriculum. Trainees and trainers should refer to the blueprints for guidance on the appropriate assessment methods for each aspect of the curriculum, and so plan the training programme according to the criteria set by the ARCP/RITA Decision Aid. It is not expected that all competencies will be assessed by all methods, rather that there will be a sampling of competencies within a variety of settings, both within formal and workplace-based assessment, from which overall competence acquisition has to be determined.
Further information on the various methods of assessment can be viewed in the Assessment section of this website.
The diagram below describes the training pathways in general terms.
Competence Based Curricula - SpR (for trainees who commenced training between 1 Jan 2003 and 31 July 2007)
The JCHMT introduced revised curricula for all the medical specialties together with a generic curriculum that applied to all trainees back in 2003. These are competence-based and set out the knowledge, skills and attitudes to be acquired by trainees before they may be awarded a CCT.
Curricula - SpR (for trainees who commenced training before 1 Jan 2003)
The curricula for trainees enrolling pre 01/01/03 are no longer available on the website but can be obtained by request to ptb@jrcptb.org.uk.